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Bilateral tubo-ovarian abscesses

Case contributed by Domenico Nicoletti
Diagnosis almost certain

Presentation

Pelvic pain and fever.

Patient Data

Age: 40 years
Gender: Female

CT abdomen and pelvis with contrast                       

  • bilateral dilatation of the fallopian tubes on both sides being distended by fluid and showing thick walls (hydrosalpinx)
  • fluid collections are present within the ovaries
  • associated with free peritoneal fluid in the rectouterine pouch
  • multiple incidental intra and extra-mural uterine fibroids

Case Discussion

Pelvic inflammatory disease (PID) affects the upper female genital tract, with infection causing endometritis, salpingitis, ovarian infections and pelvic peritonitis. The inflammation is caused by bacteria that take a retrograde route to the Fallopian tubes via the vagina and uterus, mainly secondary to intercourse. 

Salpingitis can be acute or chronic. In simple or acute catarrhal salpingitis the Fallopian tubes become red, swollen and secrete a greater amount of fluid. In most cases is caused by bacteria, the most common are: Chlamydia, Ureaplasma, gonococcal (causing gonorrhea), Mycoplasma, E. coli, Staphylococcus, and Streptococcus.

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